Individual
DR. DUSTIN ALAN WYLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
655 7TH ST, ROBINS AFB, GA 31098-2227
(503) 309-4605
Mailing address
3500 HARBISON DR APT 536, VACAVILLE, CA 95687-3917
(503) 309-4605
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D8863
OR
Other
Enumeration date
02/07/2007
Last updated
09/14/2007
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